1.Symptom tracker. This form to help you track your signs and symptoms and is a quick way to review how you have been doing over an entire month. You can copy and use this form month after month.. Download as a word document HERE or a pdf HERE or Excel document HERE..
2. Review of Symptoms. A form to bring to ANY appointment with Dr. Herbst can be found HERE.
3. White paper on Dercum's disease (DD) can be found HERE.
4. Information to help your MLD therapist take care of your and your DD can be found HERE.
5. Lower extremity functional scale - The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person’s ability to perform everyday tasks. The LEFS can be used by clinicians as a measure of patients' initial function, ongoing progress and outcome, as well as to set functional goals. The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention. Fill out and bring a copy to your healthcare provider. Download it HERE.
6. If you need supporting documentation for your insurance company for removal of excess skin, click HERE.
7. ARIZONA RESIDENTS: Department of Economic Security (DES) has a form to help with nutritional assistance. "Verification Of Medical Expenses” makes it possible for a Medical Doctor to help patients offset their out-of-pocket expenses for supplements. Verifying items such as vitamins and over-the-counter medicines is allowable. By providing DES with this documentation and receipts showing $35.00 or more in monthly out-of pocket expenses, DES would increase the monthly amount paid for nutrition.
8. HERE are what some women with fat disorders are saying about insurance coverage for liposuction.
9. Vasculera prescribing information. Vasculera reduces inflammation in blood and lymphatic vessels and improves lymphatic pumping. It also reduced acid in the tissue so it is 'alkalinizing'.
10. CH50 Complement - If your CH50 is elevated, this means that the overall complement pathway is active as part of inflammation. Please have the complement pathway further tested by filling out THIS FORM (patient information, billing information, referring physician and their signature) and choosing aHUS Complement Activation Panel on the bottom left of the 2nd page and take to your local lab.
11. Nerve antibody testing for Dercum's disease - if you have signification pain in your fat (and elsewhere in muscles, joints) consistent with Dercum's disease, please complete THIS FORM (patient information, physician/laboratory contact, insurance information, etc.). The two labs you need to have checked are on the bottom of the 4th page. These will determine whether you have antibodies against nerve electrolyte channels that affect nerve function and may participate in pain.
12. Amphetamines (Adderall, dextroamphetamine and phentermine) help improve lymphatic pumping. Insurance companies will cover this medication if you have ADD or ADHD. Use this form HERE to find out if you have either of these conditions. A check in mostly the darker boxes is consistent with ADD or ADHD.
13. If you feel ill, please fill out the Metabolic Screening Questionnaire HERE and bring to your clinic visit with Dr. Herbst and/or follow the score over time. A score of 80 or above suggests compromised health.
14. Lidocaine IV for pain - be sure to have your cytochrome P450 1A2 Genotype tested through the Mayo clinic prior to your infusion to ensure that you have the best chance of response. Test ID: 1A2. Find out more here: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/89401
15. Ketamine IV for pain - Although recent studies indicate CYP2B6 may be useful to monitor drug metabolism of ketamine, to date a comprehensive review has not established the clinical significance of this enzyme. Therefore, CYP2B6 testing does not meet the clinical utility requirements for a Medicare Benefit and is considered a statutorily excluded service. MolDX will also deny panels of tests that include the CYP2B6 gene.
16. Nicotinamide riboside (NR) - also known as vitamin B3, this powerhouse vitamin precursor of the energy molecule NAD+ has been found in mice to regenerate organs, protect nerves, protect against aging and regenerate stem cells. A white paper is available.
17. uBiome testing - If you are interested in getting your gut bacteria tested, uBiome is one of number of sites you can use that can be covered by insurance. They have a patient assistant program.
18. If you are in need of appealing the need for a panniculectomy with your insurance company please see a letter from a patient here.
19. If you think you have hypermobile EDS, fill out this form and bring with you to your appointment.
